Individual
MICAH WELLS HOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
124 SW YAMHILL ST, PORTLAND, OR 97204-3019
(541) 771-9869
Mailing address
124 SW YAMHILL ST, PORTLAND, OR 97204-3019
(541) 771-9869
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10009
OR
Other
Enumeration date
07/06/2011
Last updated
07/06/2011
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